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Click ‘Get Form’ to open the DHS 1640 Form in the editor.
Begin by filling out the Reporter Information section. Provide your name, agency, title, address, and phone number. Indicate if you are a mandated reporter or if anonymity is requested.
In the Type of Harm section, check all applicable boxes that describe the nature of the suspected abuse or neglect. Be sure to include the date of the incident and location.
Next, complete the Vulnerable Adult Information section. Fill in details such as name, date of birth, home address, gender, and living arrangement. Specify any disabilities or communication needs.
Proceed to describe the Presenting Concerns and Indicators of Harm. Check all relevant boxes and provide detailed descriptions where necessary.
Finally, complete the Alleged Perpetrator(s) section and provide any supporting documentation regarding decisional capacity if applicable.
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A written report must be completed and sent to the DHS APS after an oral report is made. Form DHS 1640, entitled Report Form for Suspected Abuse and Neglect of.
report form for suspected abuse and neglect of vulnerable adults
DHS 1640 (Rev. 3/15). Page 1 of 4. State of Hawaii. Social Services Division. DEPARTMENT OF HUMAN SERVICES. Adult Protective Community Services Branch.
Quality of Water from Domestic Wells in Principal Aquifers of
by LA DeSimone The U.S. Geological Survey (USGS) is committed to providing the Nation with reliable scientific information that helps to enhance and protect the overall
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